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Dermatologists of New Orleans Louisiana
Larry
Edward Millikan, MD
Erin
E. Boh, MD, PhD
Joseph
P. Shrum, MD
Alan
Thomas Lewis, MD
Glenn
G. Russo, M.D.
To
Read About the Tulane Dermatology Professors Click Here
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Donate to Tulane Health Science Centers in New Orleans, Please
Click Here
Additional Dermatology
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New Orleans Dermatologist and Cosmetic Surgery Information
Most people want to look and feel their best. Many of us,
at times, are not happy with the way we look. Cosmetic, or
plastic, surgery can help a person change what they do not
like about their appearance. It can make severe acne scars
less noticeable, remove fat (liposuction), lessen wrinkles,
fix crooked noses, and get rid of double chins. Women can
have their breast size increased or decreased. Lasers can
zap away varicose and spider veins and remove unwanted hair
for good.
A woman's body image can be affected by how she feels about
the way she looks. Cosmetic surgery can help a woman feel
more comfortable and confident about her appearance. For example,
women with large breasts can suffer physically and emotionally.
A woman can have an achy back, deep grooves in her shoulders
from bra straps, poor posture, and low self-esteem from comments
made about her breasts. Women with varicose veins can have
pain and swelling in their legs. It is important to remember
that cosmetic surgery is not without risk and is surgery.
General anesthesia is sometimes used and all treatments can
have side effects. Talk to your health care provider if you
are thinking about cosmetic surgery. Be aware that there are
clinics that are not licensed that make false claims about
what they can do. The National Women' s Health Information
Center has provided the following publications and organizations
for women to learn more about cosmetic surgery and maintaining
a positive body image.
Publications
-
Breast Implants
- An Informational Update
This report contains information on both silicone and
saline implants. It also also contains information on
breast feeding with implants, polyurethane foam-covered
implants, special medical and physical considerations,
breast implant and medical device reporting, and frequently
asked questions.
-
Breast Reduction
Often Good Medicine
This publication discusses breast reduction. It addresses
the medical concerns concerning the surgery and explains
how one should prepare for the procedure.
-
Cosmetic Laser
Surgery: A High-Tech Weapon in the Fight Against Aging
Skin
This fact sheet contains information on laser cosmetic
surgery. It descibes skin resurfacing, what it can do
for you, what the risks are, and how to find a surgeon.
-
Treatments
for Aging Skin (Copyright © AAD)
This web site discusses various medical proceedures available
to help the appearance of aging skin.
Organizations
-
Food
and Drug Administration, OPHS, HHS
-
American Academy
of Dermatology
-
American
Academy of Facial, Plastic and Reconstructive Surgery,
Inc.
-
American
Society of Plastic Surgeons (ASPS)
=
Federal government resources
Botulinum Toxin Type A (Botox Cosmetic) is
a protein complex produced by the bacterium Clostridium botulinum,
which contains the same toxin that causes food poisoning.
When used in a medical setting as an injectable form of sterile,
purified botulinum toxin, small doses block the release of
a chemical called acetylcholine by nerve cells that signal
muscle contraction. By selectively interfering with the underlying
muscles' ability to contract, existing frown lines are smoothed
out and, in most cases, are nearly invisible in a week.
Botox injections are the fastest-growing cosmetic
procedure in the industry, according to the American Society
for Aesthetic Plastic Surgery (ASAPS). In 2001, more than
1.6 million people received injections, an increase of 46
percent over the previous year. More popular than breast enhancement
surgery and a potential blockbuster, Botox is regarded by
some as the ultimate fountain of youth.
Botox was first approved in 1989 to treat
two eye muscle disorders--uncontrollable blinking (blepharospasm)
and misaligned eyes (strabismus). In 2000, the toxin was approved
to treat a neurological movement disorder that causes severe
neck and shoulder contractions, known as cervical dystonia.
As an unusual side effect of the eye disorder treatment, doctors
observed that Botox softened the vertical frown (glabellar)
lines between the eyebrows that tend to make people look tired,
angry or displeased. But until this improvement was actually
demonstrated in clinical studies, Allergan Inc., of Irvine,
Calif., was prohibited from making this claim for the product.
By April 2002, the FDA was satisfied by its
review of studies indicating that Botox reduced the severity
of frown lines for up to 120 days. The agency then granted
approval to use the drug for this condition.
The FDA regulates products, but not how they
are used. Approved products are sometimes used by a licensed
practitioner for uses other than those stated in the product
label. Botox Cosmetic, for example, is currently being used
by physicians to treat facial wrinkles other than those specified
by the FDA. Consumers should be aware, however, that this
"off-label" use has not been independently reviewed
by the agency, and the safety and effectiveness of Botox injections
into other regions of the face and neck, alone or in combination
with the frown-lines region, have not been clinically evaluated.
Ella L. Toombs, M.D., a dermatologic medical
officer in the FDA's Office of Cosmetics and Colors, says,
"Careful deliberation, investigation and evaluation is
undertaken by the agency before any prescription product is
approved." Drugs such as Botox, which are not indicated
for serious or life-threatening conditions, "are subject
to a greater level of scrutiny because of the benefit-to-risk
ratio." Toombs says this means that the FDA may allow
someone to incur a greater risk from products that treat medical
conditions, rather than from those that are approved for cosmetic
purposes.
Considering Botox Cosmetic?
Be sure that a qualified doctor performs the procedure.
Make sure that the doctor is trained and qualified in cosmetic
skin surgery of the face.
Ask questions and be informed about the benefits and risks
involved in the procedure.
Avoid alcohol and remain upright for several hours following
the procedure.
Choose a medical setting using sterile techniques. Necessary
equipment should be available to respond to any potential
problems.
Source: The American Society for Dermatologic Surgery
Botox 'Parties'
The recent rise in the popularity of Botox has much to do
with the manner in which it is frequently marketed. Some practitioners
buy the toxin in bulk and arrange get-togethers for people
receiving their treatments. As in business, volume discounts
can be found in medicine.
Plastic surgery events known as Botox parties--also
seminars, evenings and socials--are a key element of Botox
marketing in much of the United States. The gatherings are
thought to be a convenient means of providing Botox treatments
more economically, and may help reduce the anxiety that normally
goes along with getting an injection. Doctors are finding
that treating people in groups allows them to make the procedure
more affordable to their patients.
Here's how a "party" typically works:
A group of often nervous, but excited, middle-aged men and
women mingle in a common area. Sometimes refreshments are
served. One by one, as their name is called, each slips away
for about 15 minutes to a private exam room. He or she pays
a fee and signs an informed consent agreement. Anesthesia
is rarely needed, but sedatives and numbing agents may be
available. The practitioner injects about one-tenth of a teaspoon
of toxin into specific muscles of the forehead most often
targeted for the effect. The person then rejoins the group.
Scott A. Greenberg, M.D., a board-certified
plastic surgeon in Winter Park, Fla., has been hosting monthly
"Botox Happy Hours" in his medical office since
the drug's approval in April. Greenberg feels that these by-invitation-only
events to previous patients "are an opportunity to treat
a lot of people at one time in a relaxed but professional
atmosphere." Greenberg says there is no difference between
treating 10 people during individual office visits throughout
the day and treating 10 people individually, but in a more
socialized setting. "The important thing is that the
identical standards of medical care are maintained at these
gatherings as in a routine daytime office consultation."
Julianne Clifford, Ph.D., of the FDA's Division
of Vaccines and Related Products Applications, explains that
"Botox is licensed for marketing and distribution as
single-use vials." This means that as packaged, "each
vial is intended to be used for a single patient in a single
treatment session." Botox does not contain a preservative
against potential contamination of the product through repeated
use of a single vial. Once opened and diluted, Botox must
be used within four hours. Treating multiple people with one
vial violates product labeling, which is stated on the package
insert, the vial and the carton.
"We lose something when we mass treat,"
says Franklin L. DiSpaltro, M.D., president of the ASAPS.
"One of my concerns is that these parties are a marketing
tool--gathering as many patients as possible trivializes a
medical treatment, which could deteriorate over time into
a nonprofessional environment." DiSpaltro says there's
more to medicine "than just dispensing drugs."
The FDA is concerned that Botox has the potential
for being abused. The ASAPS recently reported that unqualified
people are dispensing Botox in salons, gyms, hotel rooms,
home-based offices, and other retail venues. In such cases,
people run the risks of improper technique, inappropriate
dosages, and unsanitary conditions. "Botox is a prescription
drug that should be administered by a qualified physician
in an appropriate medical setting," says Toombs.
Although there is no chance of contracting
botulism from Botox injections, there are some risks associated
with the procedure. If too much toxin is injected, for example,
or if it is injected into the wrong facial area, a person
can end up with droopy eyelid muscles (ptosis) that could
last for weeks. This particular complication was observed
in clinical trials.
Other common side effects following injection
were headache, respiratory infection, flu syndrome, and nausea.
Less frequent adverse reactions included pain in the face,
redness at the injection site, and muscle weakness. These
reactions were generally temporary, but could last several
months.
While the effects of Botox Cosmetic don't
last, still, people don't seem to mind repeating the procedure
every four to six months in order to maintain a wrinkle-free
look. Battling the signs of aging in a non-invasive way, after
all, is part of the allure of the product--that and the fact
that there are no unsightly scars, and that there is very
little recovery time with the procedure.
The FDA recommends that Botox Cosmetic be
injected no more frequently than once every three months,
and that the lowest effective dose should be used.
Sponsored Links:
If you are looking for help with: Please
Call: 1-877-707-2277
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- Soft
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Injections
- Hair
Removal or Reduction
- Scar
Removal or Improvements
- Laughlines
- Birthmarks
and Tatoos
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Spots
- Facial
Resurficing
- Chemical
Peel
- Liposuction
- Breast
Augmentation
- Facelift
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